Wednesday, 13 April 2011

Will GPs really be able to charge under the government's NHS reforms?

Among the details of Ed Miliband's dossier on the government's NHS reforms lies a potentially explosive proposal: GPs will be able to charge for services.

As a sentence it doesn't quite have the resonance of 'the death of the NHS', but that's ultimately what it means. If true, it would mark the end of guaranteed free, comprehensive healthcare in Britain.

So, is it true? Well, apparently yes. After reading the Labour dossier I tried to get more details from Labour and the Department of Health but neither were particularly useful (surprise!)

Instead, the best work on the subject comes from professor Allyson Pollock, from the Centre for Health Sciences. She wrote a piece in the British Medical Journal recently which you can read here. It’s detailed and complex but well worth your time.

The key clause is clause 22. It hands the health secretary the power to "make such charges as he considers appropriate" to GPs' consortia. Section nine of the bill allows GPs to determine which services are part of the health service and which are chargeable. Section seven gives them general powers to charge.

So really, the health secretary's powers to unilaterally charge for particular operations or procedures has been transferred to GPs. That doesn't seem such a big change. It almost seems as if the NHS was never that safe. But actually, GPs will be freer to charge than the health secretary ever was, because he always had to abide by the government's duty to provide comprehensive healthcare free at the point of delivery. Various government innovations – not least under Labour – have chipped away at the structures and mechanism holding that duty in place, but the transferral of the power marks a much greater change.

Not only that, but any move to charge by a health secretary would have been a major political story. By moving that decision to the local level and tasking a technical commissioning body to do it, we can assume that it would cause much less of a stir.

There are further complications. The health secretary's duty to promote a comprehensive service is replaced with a duty "to act with a view to securing" comprehensive services. His duty to provide certain services throughout the UK will be scrapped. Instead, consortia "arrange for" services to meet "all reasonable requirements". Tellingly, they can determine which services are "appropriate as parts of the health service". The duty for comprehensive services is replaced with "services… it considers appropriate".

Similarly, the existing duty on the health secretary to promote equity of access is replaced with a duty to "have regard" to the need to reduce inequalities.